POS0967 MORTALITY-RELATED HEALTH METRICS IN RHEUMATIC AND MUSCULOSKELETAL DISEASES AN EPIDEMIOLOGICAL ANALYSIS OF A NATIONWIDE REGISTER-BASED COHORT
Authors: M. Li, C. Wu, P. Yin, M. Zhou, M. Li, X. Zeng
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatic and musculoskeletal diseases (RMDs) have become leading causes of death (CODs)[1,2]. However, few study has provide an integrated overview of mortality burdens, leaving a care gap between regions[3]. Therefore, estimates on mortality burdens of RMDs and their relationships with socioeconomic factors are essential for prioritizing health policies, especially in low-to-middle income countries (LMICs). <h3>Objectives:</h3> To provide an integrated atlas of mortality-related health metrics of 9 RMDs, including RA, SpA, SLE, SS, IIM, SSc, BD, TAK, and AAV. To illustrate the associations between disease burdens of RMDs and development indicators from multiple aspects. <h3>Methods</h3> A nationwide multicentre cohort was linked to Nation Mortality Surveillance System. RMD ascertainment was based on classification criteria, death case ascertainment was following ICD-10 codes. Data collection was conducted, followed by a 3-phase imputation and sensitivity analyses. CODs, SMRs, and life expectancies were estimated. A composite indicator, human development index (HDI), and indicators in economy, healthcare, and education were adopted as area-level socioeconomic status indicators. Mixed-effects meta-regression models were established to explore impacts of socioeconomic indicators. <h3>Results</h3> Between 2008 and 2021, 175 846 individuals were included (Figure 1). AAV, IIM, and SSc ranked top 3 diseases with the highest fatality rates over 10% and lowest survival rates within 10 years after the first diagnosis of RMDs. Principal immediate CODs in patients with RMDs are shown in Figure 1. Adjusted SMR was highest for TAK, followed by IIM, SSc, SLE, AAV, BD, and SS (Figure 1). The mortality risk of patients with RA was generally comparable with overall population. Early disease-onset is a risk factor of excess death in both male and female patients with CTDs. Higher HDI was associated with significant increases in mortality risks in both RA and SLE (SMR ratio 12.24 and 5.15 for 1-unit increase in HDI, p&lt;0.001 and p=0.080) patients compared with region-specific general population. More medical institutions (SMR ratio 0.95 for 1 more medical institution per 10 000 resident population, p=0.005) and hospital beds (SMR ratio 0.35 for 1 more hospital bed per 100 resident population, p=0.131) were protect factors of excess mortality in SLE. In overall patients, SS, SLE and AAV, IIM and SSc, had mild, moderate, and strong associations with the loss in life expectancy, respectively (Figure 1). <h3>Conclusion</h3> This study relied on the biggest nationwide register-based cohort of more than 170 000 patients with RMDs confirmed by rheumatologists. We observed that mortality risk (up to 4.5 times) and loss of life years (up to 25 years at the age of 10) in patients with RMDs can be in substantial excess versus general population. Additionally, our study provides the first systematic account that the mortality burdens of RMDs have a complicate relationship with the level of regional deprivation. Increasing mortality burdens associated with RMDs implied the relative insufficiency of capacity building of diagnosis and treatment in RMDs in LMICs. <h3>References</h3> [1]Tan JA, et al. <i>Incidence and prevalence of idiopathic inflammatory myopathies in South Australia: a 30-year epidemiologic study of histology-proven cases</i>. Int J Rheum Dis, 2013. 16(3): p. 331-338. [2]Kermani TA, et al. <i>Increase in age at onset of giant cell arteritis: a population-based study</i>. Ann Rheum Dis, 2010. 69(4): p. 780-781. [3]Thomas SL, et al. <i>Burden of mortality associated with autoimmune diseases among females in the United Kingdom</i>. Am J Public Health, 2010. 100(11): p. 2279-2287. <h3>Disclosure of Interests</h3> None Declared.